Fournier gangrene: an historical reappraisal.

Perineal gangrene (synergistic gangrene), an age-old severe infectious disorder, was more completely described by Dr Robert Robertson (1742-1829) in 1777, providing much needed data on the clinical features well before Dr Jean Alfred Fournier's (1832-1914) account in 1883. Robertson's historically overlooked and detailed narrative is presented with implications, in part, refuting some conclusions made by Fournier 100 years later.

Gangrena perineal en mujer de 44 años. Hallazgos en Tomografía Axial Computarizada (TAC) / Fournier´s gangrene in a 44-year-old woman: CT scan findings

OBJETIVOS: Mostrar los hallazgos característicos en TAC y su utilidad diagnóstica en la gangrena de Fournier en mujeres.METODO/RESULTADO: Mujer con antecedentes de esfinterotomía lateral interna que acude a urgencias por intenso dolor en hipogastrio y en región perineal con endurecimiento del glúteo izquierdo. En la TAC se observa una colección abscesificada en el espacio rectovaginal y gas en músculos elevadores del ano, fosa isquiorrectal izquierda y en raíz del muslo izquierdo(AU)

OBJECTIVES: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier’s gangrene.METHOD/RESULT: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh.CONCLUSIONS: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier’s gangrene, as it shows both the origin of the infection and its extent(AU)

Fournier's gangrene: historical survey, current status, and case description.

BACKGROUND: The first-documented clinical picture of the disease was made by Fournier in 1883. Its epidemiology has changed and is much different from the original. It is infectious in its etiology, affecting mostly men between 50 and 60 years of age. Predisposing factors include diabetes, neoplasms, chronic glucocorticoid therapy, immune-compromise, chemo- and radiotherapy, immunosuppression, Crohn's disease, and alcohol abuse. High mortality results from the rapid progress of the disease, leading to quick development of septic shock and multi-organ failure. Most important in the treatment of Fournier's gangrene are surgical debridement of the wound, fascia incision and drainage of necrotic lesion, and intravenous antibiotic therapy. The typical picture of the disease might be hidden by concomitant disease. CASE REPORT: A case of Fournier's gangrene in an 81-year-old woman with concomitant neurologic complications, hypertension, cardiomyopathy, and chronic obstructed pulmonary disease is described. Three days after the suspected diagnosis, the decision was made to fully remove the necrotic tissue surgically. Despite all the efforts of the medical team, the patient died 14 days after being diagnosed with Fournier gangrene. The immediate cause of death was septic shock. CONCLUSIONS: In the early stages of the disease, before necrotic lesions occur, a final diagnosis might be difficult. In the present case, death was caused by the patient's advanced age, simultaneously appearing symptoms, and late surgical intervention, but mostly by lung failure.

Death of an Arabian Jew.

A 69-year-old Judean man presents with chronic low-grade fever, pedal edema, and abdominal pain. His condition deteriorates over several weeks with the appearance of shortness and foulness of breath, pruritus, convulsions of every limb, and gangrene of the genitalia. Just before he dies, he orders dozens of the leading men of his kingdom imprisoned and instructs his sister to kill them all after he is gone. Who is he and what is the likely cause of his death?

Gangrena de Fournier: presentación de dos casos clínicos / Fournier's gangrene: two clinical cases presentation

A partir de la presentación de dos casos clínicos de gangrena de Fournier, hospitalizados en el servicio de ginecología y obstetricia del Hospital San Juan de Dios, se realizó una revisión de esta entidad clínica llamando la atención los pocos reportes existentes en la literatura. La gangrena de Fournier es una enfermedad infecciosa de los tejidos blandos, causada por la acción sinérgica de varios microorganismos aerobios y anaerobios. Su mortalidad es alta (21 por ciento), con oscilaciones de 7 a 75 por ciento. La incidencia actual es baja, no obstante cuando se presenta constituye a una urgencia quirúrgica. Entre los factores determinantes y con valor pronóstico destaca la diabetes, la inmunosupresión y las infecciones urinarias o rectales.

Celulitis necrotizante: Síndrome de Fournier / Perianal necrotizing celulitis: Fournier Syndrome

Introducción: La celulitis necrotizante perineal es una infección perineal grave, poco frecuente, descripta por Fournier en 1883. Luego de los conceptos históricos de Jones, Meleney, Wilson y Fournier, se describe el concepto actual de la patología. Como objetivo se buscan coincidencias entre este concepto y nuestra experiencia. Diseño: Retrospectivo sobre Historias Clínicas de pacientes asistidos en el Servicio de Coloproctología. Pacientes y métodos: En este trabajo se reportan 17 casos asistidos en hospital público entre marzo de 1980 y marzo 2001. El promedio etario fue de 53 años, con preponderancia del sexo masculino. Se describe patogenia, clínica, bacteriología, tratamiento médico y quirúrgico y evolución. Resultados: Coincide con otros autores en la forma de comienzo de la enfermedad y tipo de infección bacteriana. Supera levemente la media etaria. Disiente en la extensión local y morbimortalidad. Discusión: Se nombraron los diagnósticos diferenciales; se describe clínica y fases de evolución de la enfermedad y se pone en evidencia la importancia para diagnóstico y tratamiento de los factores predisponentes y desencadenantes. Conclusiones: El tratamiento de esta patología en tres aspectos: el del shock, antimicrobiano y quirúrgica precoces parecen ser los pilares que mejoraron la morbimortalidad de esta enfermedad. (AU)

Gangrena de fournier y otras infecciones necrosantes / Fournier gangrene and other necrotizing infections

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